Orthopedic plate for use in small bone repair

ABSTRACT

The present invention relates to a series of orthopedic plates for use in repair of a bone. The plate has a Y-shaped profile or an X-shaped profile which includes an elongate central trunk with a complex contour and either one or two terminal pairs of arms that have a first arm and a second arm that form differing angles and lengths relative to the trunk portion of the plate. The arms include locking screw holes where the screws converge toward each other to provide for multiplanar fixation but which do not impinge.

CROSS-REFERENCE

This application is continuation application of U.S. patent applicationSer. No. 13/348,888, filed on Jan. 12, 2012 for ORTHOPEDIC PLATES FORUSE IN CLAVICLE REPAIR AND METHODS FOR THEIR USE which is a divisionalof U.S. Pat. No. 8,118,846, issued on Feb. 21, 2012 for ORTHOPEDICPLATES FOR USE IN CLAVICLE REPAIR AND METHODS FOR THEIR USE which is aCIP of U.S. Pat. No. 7,771,457, issued on Aug. 10, 2010 for ORTHOPEDICPLATE FOR USE IN SMALL BONE REPAIR which claimed priority to U.S.Provisional Application Ser. No. 60/648,364 filed on Jan. 28, 2005 forORTHOPEDIC PLATE FOR USE IN SMALL BONE REPAIR.

FIELD OF THE INVENTION

The present invention relates to orthopedic plates in particular forsurgical repairs or reconstruction of a clavicle and to a method for theuse of these plates.

BACKGROUND OF THE INVENTION

The field of orthopedic medicine has grown tremendously in the pastfifty years as surgical techniques, implants and instrumentation havedeveloped and been improved. The small bones are frequently subject tothe need for re-constructive surgery for example, as a result of trauma,to counteract the effects of aging or to repair congenital deformitiesand trauma and spinal areas. While there is a wide variety in the exactshape and mass of all bones, these variations become more problematic inproviding orthopedic implants for small bone applications since there isless room on and about the bone for the surgeon to place and fix theconstruct. These bones are finer and have less surface area forplacement of an implant, have less mass for the placement of screws andare often surrounded by less muscle and by more vulnerable tendons,blood vessels and nerves. As a result, individual variations become moreproblematic for orthopedic plates of stock design. Consequently,surgeons have tended to rely on the use of screws and wires forreconstruction or have had to resort to operating room contouringprocedures which can weaken the plates and/or distort the screw holeswithin the plates. This is a particular problem in instances in whicheither variable locking mechanisms are used, or in which locking screwsare used with the plates. None-the-less, locking screws often are usedto advantage as they provide more secure placement of the screws in thebone, cause better compression through a fractures, and are less likelyto harm the bone or back out of the plate.

One problem that needs to be avoided in the delicate environment of thesmall bone area is the interference of screws, with other screws, andwith the function of ligaments and tendons. While it may be desirable todesign an orthopedic plate so that securing screws converge in order tocause compression or increase the pullout strength, it is difficult whena screw impinges on or conflicts with the desired placement of anotherscrew. Some surgeons prefer bicortical fixation in which a screw issized so that the distil end is secured in cortical bone giving thescrew better purchase, however, other surgeons may prefer to avoidplacing a screw so that it projects beyond the outer surface of theanchoring bone. These factors are complicated by the relative lack ofsoft tissue and the presence of ligaments and tendons in the small boneareas. Consequently, the less forgiving biological environment in whichthe small bone surgeon works requires greater procedural precision andcalls for specialized implants and tools.

The present invention is designed to meet the specific needs of thesmall bone surgeon to facilitate effective and repeatable procedureswhich provide for ease of use and a range of function for this specificarea of specialization. The present invention is specifically intendedto provide for the treatment of fracture repair following trauma in anotherwise healthy individual where plates are used to maintain theintegrity of the bones while they heal, although it is certainlypossible that they may also be used for other surgeries such asreconstruction to correct congenital or age related deformation orissues that relate to prior mal-union of the bone following a priorinjury.

The plates of the present invention are designed specifically for therepair or reconstruction of a clavicle, which is commonly called a“collarbone”. The collarbones, like the cheekbones, are covered only byskin, and thus have a high correlation to the appearance of theindividuals and serve in many cultures as a marker of beauty. Thesebones further serve to protect the brachial plexus and the medial nerveand blood vessels that are immediately internal to them. They also serveas a strut and the only skeletal connection between the arms and thetorso, and they play a very sophisticated role in the functioning of theshoulder girdle, torso, scapular and arm kinesiology. The effect ofmisalignment and mal-union of clavicle fractures are only recently beingexamined from the viewpoint of the strength and stamina of the patientas it was previously viewed radiographically and thereforeunderestimated.

It has been reported that as many as 5% of all fractures seen in theadmissions department of an emergency room are clavicle fractures, whichoccur most commonly between the proximal ⅔ and the distal ⅓ of the bone.The more common fracture (approximately 80% of clavicle fractures)occurs in the middle third of the clavicle with an upward displacementof the proximal fragment of the bone by the stemocleidomastoid muscle.The weight of the shoulder muscles and of the adductor muscles of thearm may add to the fragment displacement, causing the shoulder to droop.This type of fracture often occurs as a result of a fall on anoutstretched hand or of a direct blow to the clavicle. The second mostcommon fracture (which may account for 10-15% of clavicle fractures)occurs in the distal ⅓ of the clavicle. The causes of the fractures aresimilar to those for the mid-shaft fractures, but also commonly includeblows to the shoulder region, such as occur in automobile collisions andparticularly physical sports such as hockey, lacrosse and football.Medial fractures are often associated with very severe trauma thatincludes injury to the vital organs and other indications ofco-morbidity.

It is often difficult to reduce and subsequently to maintain thereduction of clavicle fractures without surgical intervention, althoughboth union and healing proceeds rapidly, usually with the result of aprominent callus, and in some cases of mal-union, with the possibilityof medial cord nerve symptoms. In the past, non-surgical treatment hasoften involved immobilization of the associated limb, such as in afigure-of-eight bandage or a simple sling. In a study published in theJournal of Bone and Joint Surgery, 2006 (88: 35-40), by McKee et al,Deficits Following Non-operative Treatment of Displaced Mid-shaftClavicle Fractures, the authors in particular note that that there was asubstantial loss of strength and endurance in clavicle fractures treatedwith a traditional sling approach, indicating substantial residualdisability despite apparently adequate range of motion. This and otherstudies have led to increased concern about providing wider range ofsurgical options for internal stabilization of the clavicle. However,the problem remains that the shape and size of clavicles vary greatlyand their visibility leaves little room for plates that do not generallyaccommodate this variation gracefully.

The present invention provides answers to the prior art issues byproviding a variety of plates with varying footprints that share anelongate central trunk with a medial line (which is intended in thisinstance to include a curving line) that divides the plate in halflaterally. The plate further has at least one pair of terminalasymmetrical arms that extend from the trunk at differing anglesrelative to the medial line and have differing lengths. The plates alsohave varying profiles (or contouring) in the z direction but again sharea transverse curve along the medial line about the side which faces thebone. The plates also all exhibit bilateral asymmetry (meaning that theleft half of the plate is not exactly the same as the right half ofplate taken from the medial line) and they all achieve bi-planar screwfixation (meaning that the screws do not lie in a single plane). Inaddition, while the plates are pre-contoured, the plates are designed tofacilitate three dimensional contouring (at least in the terminal arms)to accommodate individual variation in bone shape. The plates areconfigured to bend laterally, longitudinally, and to wrap or spiralabout the longitudinal axis or medial line so that they can be molded toan optimal shape for small bone procedures. The plates are designed toprovide optimal stabilization of fractures and osteotomies by providingmulti-planar fixation that allows for better pull-out and limited axialloading to the bone. The plates are further designed to acceleratefusion success by reducing or eliminating torsional or twisting stressesto the bone segments during the healing process. In addition, whendesired, the plates can be shaped so as to apply a compressive, or evena tensile, force, for example, along the longitudinal axis of a bone.

These plates are provided in a number of variations in a surgical tray,which include for example various lengths of the central trunk portion,which is provided with a line of screw holes centered along the medialline. Further the number of screw holes in the trunk can vary, and thetype of holes can vary to include translation slots, compression slots,and locking and non-locking screw holes. Thus, the tray selection allowsthe surgeon to select his plate during surgery after opening the woundarea and considering the plating needs. In addition, the tray includesplates of differing types for differing placement on the clavicles. In afirst embodiment of the clavicle plate of the present invention, a plateis provided for placement on the superior aspect of a clavicle, and in asecond embodiment, a plate is provided for placement on theanterior/inferior aspect of a clavicle, and in a third embodiment, aplate is provided for placement on the lateral aspect of a clavicle.

All of the plates have an elongate central trunk portion including oneor more screw holes which are optionally separated by a waist shapedlinking portion along a longitudinal axis or the medial line anddepending on the embodiment, the plate has one pair or two pairs of armswhich are preferably terminal to the central trunk, and which includescrew holes (i.e. one per arm) placed at an equal distance from thelongitudinal axis but which diverge asymmetrically from the longitudinalaxis to avoid conflicts in the screw placement of the paired arm,specifically, so that the screws of a set of arms avoid impinging oneach other and further to provide multiplanar fixation at the plateterminus. The plate is curved about the inferior surface, (i.e. thesurface which faces toward and which may, but does not have to fullycontact the bone), with a curvature corresponding generally to thecurvature of a bony surface. In most of the embodiments of the platethis contouring is the result of a blending of one or more series ofradiuses so that the plate may comprise a portion of a cylinder, orportions of a cylinders, or in the event that the medial line alsodefines a longitudinal curve in the z axis, a portion of a torroid. Thepair of arms continue this curvature to spiral or wrap around the bonelike a small portion of a double helix (i.e. extending through an arc ofless than about 50°). The screw holes within the arms are placed so thatthe angle of the longitudinal axis of the screws converge in thedirection of the distil end of the screw. The screw holes are placedwith the longitudinal axis perpendicular to a tangent to the top surfaceof the arm with the effect that the longitudinal axes of the screwsconverge in the direction of the distil end. The convergence of thescrew holes increases the pull-out strength of the screws.

Further the screw holes are rounded and the corresponding mating headsof the screws are rounded and have a low profile so that the screws canbe seated with their longitudinal axes at a variety of angles.Preferably, there is at least 20° of conical rotation, and morepreferably 25°, and most preferably 30° of conical rotation of the screwaxis in relation to the longitudinal axis of the screw hole (i.e. thelongitudinal axis of the screw can be rotated through a conical shapeabout the axis of the screw hole where the apex of the cone describes anangle of 30°). Alternatively and in many cases, preferably, the screwholes can include internal threads which mate with external threads onthe head of the screws to cause locking of the screws relative to theplate.

While the screws are at convergent angles, the screws typically do notin fact impinge on each other, or conflict in their placement since eachof the arms of the plate in a pair form a different angle to the centraltrunk so that the longitudinal axis of the screws are offset from eachother along the length of the plate. The radiused configuration of theplate is designed to increase operating room efficiency by facilitatingcommonly desirable shapes while maintaining the required strength and bypermitting bending without deforming the screw holes. This results inmaking customization in anticipation or during surgery easier.

The surgical tray of the present invention further includes a variety ofscrews. The screws useful with the plate of the present invention areself-starling, self-tapping screws including the option of partial orfull cannulation. The screws include a unique cutting end havingmultiple flutes, and preferably 2 or 3 flutes about a conical recess.The screws further include a partial taper of the inner diameter in theproximal end over the first several thread turns, for example over 2-8,and preferably over 3-5 turns in order to increase the fatigue life ofthe screw as well as providing potential physiological advantages inuse. The screws further include a torque driving recess that may be ahexagon, a torx shape, or a modification of a torx shape, i.e. amultilobe shape having from 3 to 12 lobes, and preferably having 4 to 8rounded recesses or lobes. The recess can be of a constant size in thedirection of the longitudinal axis, or can taper inward along thelongitudinal axis of the screw toward the bottom of the recess. Thescrews have a low profile, head which is rounded at the junction of thehead and the shaft, and also rounded from the maximum diameter towardthe top surface or the proximal end relative to the insertion tip, whichincludes the torque driving recess. This rounded low profile head keepsthe screw from having any sharp projecting edges which could provide anirritation to the tissue in the vicinity of the plate and further seatsin the plate so that no more than 10% by volume of the screw headprojects from the plate.

The instruments for use with the system are well-balanced andergonomically designed with sufficiently long handles to place thesurgeon's hands outside of the line of radiation and designed to reducefatigue in the operating room.

Depending on the intended placement of the plate, the central trunk, andthe plate itself includes a general topography (i.e. the contour in thez direction) designed to maximize the fit on a variety of shapes andsizes of clavicle while enabling, but reducing the need forindividualized contouring. This topography includes a c-shape lateralcurve in the superior and 4-hole anterior plates, a fishtail (i.e.having a broad curve in the direction of the bone-facing surface of theplate terminating in a short up-turned curve at the end of the plate)shape in the longer anterior plates. The lateral plate has an S-curve ofthe medial line in the direction of the width of the plate. The platesystem of the present invention is thus designed to fit a range of needsof the surgeon operating on the clavicles to allow him or her to perfecta variety of techniques using a set of instruments and a customizableplate and screw construct.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a top view of a first embodiment of an orthopedic plate inaccordance with the invention;

FIG. 2 is a cross-section of the plate of FIG. 1 taken along line 2-2;

FIG. 3 is a cross-section of the plate of FIG. 1 taken along line 3-3;

FIG. 4 is a cross-section of the plate of FIG. 1 taken along line 4-4;

FIG. 5 is a cross section of the plate of FIG. 1 taken along line 5-5;

FIG. 6 is a perspective view of a screw used with the present system;

FIG. 7 is a perspective view of a locking screw used with the presentinvention;

FIG. 8 is a top view of a first version of a second embodiment of theplate in accordance with the invention;

FIG. 9 is a cross section of the plate of FIG. 8 taken along line 9-9;

FIG. 10 is a mirror version of the plate shown in FIG. 8;

FIG. 11 is a cross section of the plate of FIG. 10 taken along line10-10;

FIG. 12 is an end perspective of a left version of a third embodiment ofa plate in accordance with the invention for placement on the anterioraspect of a clavicle;

FIG. 13 is a top view of the plate of FIG. 12;

FIG. 14 is a right end view of the plate of FIG. 12;

FIG. 15 is a right side view of the plate of FIG. 12;

FIG. 16 is a cross section of the plate of FIG. 12 taken across thewidth of the plate;

FIG. 17 is view of the plate of FIG. 12 placed on a clavicle;

FIG. 18 is an end perspective of a left version of a fourth embodimentof a plate in accordance with the invention for placement on theanterior aspect of a clavicle;

FIG. 19 is a top view of the plate of FIG. 18;

FIG. 20 is a right end view of the plate of FIG. 18;

FIG. 21 is a right side view of the plate of FIG. 18;

FIG. 22 is a cross section of the plate of FIG. 18 taken along line22-22;

FIG. 23 is view of the plate of FIG. 18 placed on a clavicle;

FIG. 24 is a top view of a left version of a fifth embodiment of a platein accordance with the invention for placement on the anterior aspect ofa clavicle;

FIG. 25 is an end perspective of the plate of FIG. 24;

FIG. 26 is a right end view of the plate of FIG. 24;

FIG. 27 is a right side view of the plate of FIG. 24;

FIG. 28 is a cross section of the plate of FIG. 24 taken along line28-28;

FIG. 29 is view of the plate of FIG. 24 placed on a clavicle;

FIG. 30 is an end perspective of a left version of a sixth embodiment ofa plate in accordance with the invention for placement on the superioraspect of a clavicle;

FIG. 31 is a top view of the plate of FIG. 30;

FIG. 32 is a right end view of the plate of FIG. 30;

FIG. 33 is a right side view of the plate of FIG. 31;

FIG. 34 is a cross section of the plate of FIG. 30 taken along line34-34;

FIG. 35 is view of the plate of FIG. 30 placed on a clavicle;

FIG. 36 is an end perspective of a left version of a seventh embodimentof a plate in accordance with the invention for placement on thesuperior aspect of a clavicle;

FIG. 37 is a top view of the plate of FIG. 36;

FIG. 38 is a right end view of the plate of FIG. 36;

FIG. 39 is a right side view of the plate of FIG. 36;

FIG. 40 is a cross section of the plate of FIG. 36 taken along line40-40;

FIG. 41 is view of the plate of FIG. 36 placed on a clavicle;

FIG. 42 is an and perspective of a left version of an eighth embodimentof a plate in accordance with the invention for placement on the lateralaspect of a clavicle;

FIG. 43 is a top view of the plate of FIG. 42;

FIG. 44 right and view of the plate of FIG. 42;

FIG. 45 is a right side view of the plate of FIG. 42;

FIG. 46 is an right and view of the plate of FIG. 42; and

FIG. 47 is a view of the plate of FIG. 42 placed on a clavicle.

DETAILED DESCRIPTION OF THE INVENTION

The plate 10 of the present invention is shown having a bilaterallyasymmetric shape with either one or two pairs of legs extending from acentral trunk portion 12 defining the longitudinal axis of the plate. Asshown the trunk portion 12 includes two screw holes or slots 14 alongthe longitudinal axis. However, as can be seen from FIGS. 12 through 18the plate can be presented in a version which has a plurality of screwholes, for example up to 8 or more. The number of screw holes in thetrunk portion 12 will depend on the length of the plate, and may rangefrom 0 to 8, and more preferably from 2 to 4. In one embodiment theseholes are compression holes or translation slots. The compression holes14 are preferably slotted or elongated and optionally may have a largerradius area 11 on each of the screw holes facing in the same direction,and a smaller radius area 13 in order to induce a compression toward thesmaller radius end. The holes may also or alternatively have a shallowshoulder or lip 18 which descends toward the inferior surface of theplate to allow the plate to be set initially and subsequently to beslide into a different position as the screws are tightened down. Thisallows compression to be applied across the middle of the trunk section.The plates include a visual indicator of the direction of thecompression, such as an arrow 17. Further, the screw holes can includeannular rings of increased thickness in the vertical direction aboutthrough holes 14.

The through holes 14 in the trunk portion 12 have a longitudinal axisthat is perpendicular to plane tangent to the top radius of the plate.The area linking the screw holes has a decreased width so as to define awaist area 26 that will bend laterally (or “curve”) relative to thelongitudinal axis and which will bend longitudinally to form a curvedarea in and out of the plane of the plate. This thinner area alsofacilitates twisting of the plate so as to allow the plate to spiral, orwrap around it longitudinal axis. The increased annular area around thethrough bores resists deformation when a bending device is used to applya force to the plate through the screw holes.

The plate 10 also includes at least one set of arms 20. As viewed inFIG. 1, these sets of arms can be viewed as a set of a short 22 and along arm 23. Each of the arms in a set includes screw holes 24 which areplaced at a radially equal distance but which diverging asymmetricallyfrom the longitudinal axis of the plate 10. More specifically, each setof arms includes one arm that defines a smaller angle of divergence afrom the longitudinal axis of the trunk portion than the angle ofdivergence of the other arm 13. For example, the first angle shown inFIG. 1 at α may be from about 5° to about to 25°, and more preferablyfrom about 10° to about to 20° and most preferably from about 12° toabout to 16°, while the second angle shown at β from about 10° to aboutto 35°, and more preferably from about 15° to about to 30° and mostpreferably from about 22° to about to 26° with a preferred difference inthe angles beings from about 2° to about to 20°, and more preferablyfrom about 4° to about to 16° and most preferably from about 8° to aboutto 12°.

In addition to the angled arms of this asymmetrical shape facilitating avariety of useful positions in the small bone area, the plate of thepresent invention is sized to fit the needs of the small bonespecialist. For small bone usage, the total length of the plate alongits longitudinal axis is from about 25 mm to about 80 mm, depending onthe number of screw holes in the trunk portion. The total width is fromabout 12 mm to about 18 mm, with an inferior radius of curvature ofabout 8 mm to about 12 mm and a concentric radius on the superior side.Typically, the waist area measures from about 7.5 mm to about 10 mm fromthe center of the larger, i.e. about 3.8 mm, radiused portion of theholes. The trunk portion has a width of about 7 mm to about 9 mm wide atthe wider parts and about 3 mm to about 5 mm wide at the narrower waistportion. The longer arm has a length along the longitudinal axis of theplate from the center of the screw hole to the center of the plate for atwo-hole trunk of from about 12 mm to about 16 mm, with a width of about3 mm to about 5 mm. The shorter arm has a comparable length of fromabout 7 mm to about 15 mm with a narrowed width of about 2.5 to about 5mm. In a further embodiment the plate could be modified for use in thelong bones with a length of up to about 400 mm with a width of up toabout 50 mm, and proportional sizes for the arms and thickness.

On the inferior side, or the side that would be facing (whichcontemplates opposing or touching or partially touching) the bonesurface in use, the arms continue the radius of curvature of the trunkportion. The superior or top side of the plate has a similar radius ofcurvature as the top surface of the plate has an outline thatcorresponds with the shape of the bottom of the plate (excluding theoptional thickened annular area surrounding the screw holes which wouldact to shield these holes against deformation during bending.) The screwholes also include a rounded concavity to mate with the rounded shape ofthe head of the screw to allow of variable axis positioning. The screwholes 24 are placed with the longitudinal axis perpendicular a tangentto the top surface of the arm with the effect that the longitudinal axesof the screws converge in the direction of the distil end. Thisincreases the pull-out strength of the plate/screw construct. Since thearms are asymmetrical relative to each other, and in particular sincethey diverge from the longitudinal axis of the trunk portion atdiffering angles, conflicts in the positions of paired screws is avoidedso that the screws of a set of arms typically do not impinge on eachother. This is even more important in instances where the plate is bentaround the longitudinal axis so as to wrap around the longitudinal axisof the bone.

The arms 20 also each include a screw hole 24 which, like the trunkportion 12 has a linking portion 26 that joins the screw hole to thetrunk portion. Again this design facilitates the desired bending whileresisting deformation of the screw holes 24 when they are used with thebending instrument to contour the plate. The angle of the arms 20 ofeach one of a pair of arms (both top and bottom and right and leftpairs) varies so as to create a bilateral asymmetry, meaning that theplate is not symmetrical with respect to a plane that passes through thelongitudinal axis in the vertical direction from the superior (the topside relative to the bone) to the inferior side (the side facing thebone), the “first plane”.

The screws holes of the trunk portion can include means to induce acompressive force in one direction, such as a ramped area on each screwhole. These ramped areas would be ramped on the same side of the holeslooking down from the top of the plate. Typically the first screwimplanted stabilizes and the second screw is used to achievecompression. Further the length of each of the arms of a pair will varyso that the radial length of the center of the screw hole to theintersection with the longitudinal axis will be the same. As shown inFIGS. 3-5, the plate includes a radial curve about the longitudinalaxis. The radius is typically about 10 mm with a transverse dimensionfrom the edge of one arm to the edge of the other arm of a pair beingabout 15 or 16 mm for typical small bone usage, and the screw borehaving a longitudinal axis of about 24° to a plane passing through thelongitudinal axis of the plate. The bores are typically about 3.75 mmfor a 3.5 mm diameter screw for small bones excluding the smallest ofapplications which would include phalanges. Again, for the smallestapplication as well as long bone embodiments the screws andcorresponding screw holes could be sized to range from a 1.5 mm diameterscrew up to a 7.5 mm diameter screw. In a further embodiment, the borecould be threaded.

FIG. 6 shows a screw 81 which could be used with the plate system of thepresent invention. The distil end of the screw can include a cutting tipwhich is self-starting and self-tapping or a rounded blunt tip. Thisaspect is defined by a conical recess and a plurality of flutes. Thesescrews 81 can optionally include partial or full cannulation. The headof the screw 82 is spherical and includes a torque driving recess, suchas a modified multilobe shape. The screw has a cancelleous thread 83with a constant major diameter and a minor diameter that tapersproximally in order to increase fatigue life of the screw and to improvecompression and compensate for bone resorption. FIG. 7 shows a lockingscrew 86 which could be used with the present invention. The screwincludes the same features as the screw in FIG. 6, except that the screwfurther includes external threads 88 on the screw head.

FIGS. 8 through 11 show a second embodiment of a plate in accordancewith the present invention in which the plate shown in FIG. 10 is amirror image of the plate shown in FIG. 8. In this embodiment, the plate71, 71′ has a Y-shape with an elongate and cylindrical central trunkhaving a single pair of arms 72, 72′ extending as previously describedfrom the a trunk portion 73, 73′. The trunk portion optionally has oneor more compression slots 74,74′.

FIGS. 12 through 17 show an embodiment of the present invention forplacement on an anterior aspect of a left clavicle with the version forthe right clavicle being a mirror image. This embodiment of the plate210 has a profile having a central trunk 212 with two sets of terminalarms 220 similar to the plates shown in FIGS. 1-5 except that the shortarms extend away from the same side of the trunk relative to the medialline. Thus, the plate forms an X with two short arms 213 on the sameside and two longs arms 214 on the same side and the elongate centraltrunk 212 bridging the span between each terminal set of arms. Thecentral trunk includes a slight longitudinal curve, and the bottom 227of the plate has a radial curve as can be seen in the end view of FIG.14, and in the cross-section shown in FIG. 16. Thus, the plate forms asegment of a torroid. The trunk includes two translation slots 230,which are obround and in the middle of the plate and which are used forinitial fixation and which subsequently allow for translation of theplate relative to that fixation. The plate further includes two screwholes 232 which are shown as locking holes having internal threads.These holes further include keyways 233 for the mating portion of adrill guide in order to set the pilot hole for a locking screw receivedin these holes.

The plate 210 has a two pairs of arms 220 that extend as previouslydescribed. Specifically, for each pair of arms, each of the first 213and second arm 214 include a screw hole 235 which defines an axis of thescrew (perpendicular to a tangent at the diameter of the screw hole) andthe arms have a longitudinal axis which is a line intersecting the screwaxis and the longitudinal axis of the central trunk. The arms spiral orwrap around in the same direction that the central trunk does. The screwholes 235 are preferably threaded locking holes, which also includekeyways for a drill guide that sets the angle for the locking screw. Foreach arm, the longitudinal axis defines an angle relative to thelongitudinal axis of the central trunk, and the angle is different forone arm than for the other arm in a terminal pair as is shown for theembodiment shown in FIG. 1. The plate demonstrates a mirror symmetryabout the transverse plane since the two short arms have a correspondingangle, length and shape and the two long arms have a correspondingangle, length and shape.

As has been previously described, the pair of arms include an inferiorcurve in the same direction as the radial curve in the central trunkportion. The difference in the length and angles of the arms allows formultiplanar fixation and convergence of the screws (which are lockingscrews) while avoiding impingement of the screws with each other. Thus,the plate is designed to fit the lateral ⅔ of the clavicle and the armsare designed wrap around the shaft of the bone. The plate is shown witha central trunk that includes two obround slots in the central trunk andtwo locking screw holes that include internal threads and keyways for adrill guide to set the angles for the screws. The plate also includestwo terminal sets of arms each having a short arm and a long arm withthe short arms on the same side for ease of insertion through theincision. The plate can have one or no slots and from 1 to 8 screwholes. FIG. 17 illustrates the placement of the plate on theanterior/interior aspect in the mid-shaft portion of a clavicle.

FIGS. 18-29 show two slightly different embodiments of the plate of thepresent invention which vary according to the length of the elongatecentral trunk and accordingly, to the number of screw holes in thissection of the plate. However, in both versions, the plate 310, 310′ hasa y-shaped footprint which comprises an elongate central trunk 312, 312′having a medial line and along the medial line, through holes, (whichcan either be slots 316, 316′ such as compression slots or translationslots) and/or screw holes 317, 317′ (which can either be smooth forvariable locking or threaded for locking holes). In these embodiments,the holes of the central body are aligned with their centers along astraight medial line (or in this instance a plane), which divides theplates in two lateral halves. The area between the through holes curvesinward toward the medial line to allow the plate to be further contouredwithout deforming the holes.

One end of the central trunk includes a single pair of arms 320, 320with a longer arm extending at a first angle from the medial line of theplate and having a shorter length than the second arm which extends fromthe plate at a second angle and has a longer length. The arms include arounded portion 324, 324 that defines a portion of a circle and has alinking area that has a smaller width than the diameter of the circle.Each rounded portion includes a screw hole 326, 326 may advantageouslyinclude internal threads 328, 328′ and keyway grooves 329, 329′ for adrill guide. These embodiments of the plates are provided in a firstversion having five locking holes 317, in the central trunk and threeobround translation slots 316. The translation slots 316 may includecontouring with in the lateral edges of the slot that are convex toreceive the rear shoulder or rounded portion of the screw in order tocause the screw to seat in the plate perpendicularly to the medial line.The plate is provided in a right and a left version and the left versionis illustrated in the figures. In this version, the plate is curvedalong the medial line transverse to the medial line as can be seen inFIGS. 20 and 22. The plate also includes a larger contouring which islike the shape of a fishtail in that it bows gently from the end withthe pair of arms in a first direction for approximately the first ¾ to9/10 of the length of the plate, and then curves more sharply in theopposite direction along the z axis.

In the longer version of this plate 310′, the plate includes fourobround translation slots 316′ which are in the center between threelocking screw holes 317′ at the end with the arm 320′ and four lockingscrew holes 317′ at the other end of the central trunk. This plate hassimilar contouring to the shorter version of this plate, with a radiuson the bottom and a fishtail curve with a longer, and shallower curvewhich defines a curve that bows in a first direction from the armsthrough the second of the second set of locking holes, and the plateincluding the last two locking holes defines a curve in the oppositedirection. Both of these plates are designed for placement on the middleportion of a clavicle and the choice between the two versions depends onthe placement and nature of the fracture involved.

FIGS. 30 through 41 illustrate plates that are intended for use on thesuperior aspect of the clavicle. Again, left versions are shown, withthe right version being mirror images of the left version. These plates410, 410′ have elongate central trunk portions 412, 412′ with twoopposing pairs of arms 420, 420′. Each of the first 413, 413′ and secondarm 414, 414′ of a pair of arms 420, 420′ include a screw hole 435, 435′which defines an axis of the screw (perpendicular to a tangent at thediameter of the screw hole) and the arms have a longitudinal axis whichis a line intersecting the screw axis and the longitudinal axis of thecentral trunk as medial as possible to the arm. The arms spiral or wraparound in the same direction that the central trunk does. The screwholes 435, 435′ are preferably threaded locking holes, which alsoinclude keyways for a drill guide that sets the angle for the lockingscrew. For each arm, the longitudinal axis defines an angle relative tothe longitudinal axis of the central trunk, and the angle is differentfor one arm than for the other arm as is shown for the embodiment shownin FIG. 1. The plates demonstrates a mirror symmetry about thetransverse plane since the two short arms have a corresponding angle,length and shape and the two long arms have a corresponding angle,length and shape.

The central trunk in the two versions shown in FIGS. 30-41, (with theshorter version shown in FIGS. 30-35 and the longer version shown inFIGS. 36-41,) varies by the length and accordingly by the number ofthrough holes in the trunk. In the shorter version, there are twotranslation slots 416 that are aligned along the medial line and areflanked by a first locking screw hole 417 and a last locking screw hole417. This area of the plate also includes curves between the screw holethat allow the plate to be contoured without bending the through holes.The plate had a shallow longitudinal C curve in the direction away fromthe shorter arm side of the plate. The bottom side 427 of the plate alsoincludes a radius to better accommodate the shape of the bone.

The version of the plate shown in FIGS. 36-41 has a longer central trunk412′ which includes four translation slots 416′ aligned along the medialline and flanked by two locking screw holes 417′. Again, the centraltrunk portion of the plate curves gently in the direction of the shorterarms and the bottom 42T of the plate includes a radius. FIG. 35 showsthe placement of the shorter plate on the inferior spine of a clavicle.

FIGS. 43-47 illustrate a plate for use on the lateral aspect of theclavicle. This plate 510 has an x-shaped profile, with an elongatecentral trunk and a first pair of arms 520 which extend at differentangles and for different lengths from the trunk and further whichinclude a curve on the bottom side so that the arms spiral around thebone and the screws that are placed in screw holes 535 in the armsprovide for multiplanar fixation and do not impinge on each other. Thecentral trunk includes two translation slots 516 and two locking screwholes 517 in the proximal end of the plate (i.e. adjacent to the endwith the pair of arms 520). The other end of the plate includes a pairof arms 530 that differs from the other pairs in that there is a neckedtransition area 531 including screw holes 532 that are aligned with theterminal screw holes 533 in these arms. There is again a shorter arm 540and a longer arm 541, which include threaded locking screw holes andkeyway guide grooves. The plate has a shallow S shape along the medialline with the more proximal of the two translation slots marking thetransition between the lobes of the S. The plate includes a bottomradius. FIG. 47 shows the plate in position on the distal portion of aclavicle.

While in accordance with the patent statutes, the best mode andpreferred embodiment have been set forth, the scope of the invention isnot limited thereto, but rather by the scope of the attached claims.

What is claimed is:
 1. A method of conducting a surgery on a bone in apatient comprising the steps of: positioning a plate system on the bone,the plate system comprising a pre-contoured plate having an elongatetrunk which extends along a longitudinal medial axis and at one end ofthe longitudinal medial axis only a first arm and a second arm, thefirst arm having a first arm linear medial axis and an ear with at leastone screw hole defining a first screw axis, the first ear being attacheddirectly to the trunk by a linking section having a waist, a first anglebeing defined by an intersection of the medial longitudinal axis of thetrunk with the first arm linear medial axis, and a first length beingdefined by a line from a center of the first arm screw hole along thefirst arm linear medial axis to the medial longitudinal axis of thetrunk, the second arm having a second arm linear medial axis and asecond ear with at least one second screw hole defining a second screwaxis, the second ear being directly attached to the trunk by a linkingsection having a waist, a second angle being defined by an intersectionof the medial longitudinal axis of the trunk with the second arm linearmedial axis, and a second length being defined by a line from a centerof the second arm screw hole along the second arm linear medial axis tothe medial longitudinal axis of the trunk, and the first angle and thefirst length being different from the second angle and the second lengthwhereby the first arm and the second arm diverge from the end of thetrunk asymmetrically relative to the other arm, and the first arm andsecond arm each including at least one threaded screw hole, and;inserting a first locking screw having a proximal end and a distal endinto the threaded screw hole of the first arm, and a second lockingscrew having a proximal end and a distal end into the threaded lockingscrew hole of the second arm so that the proximal end of the firstlocking screw is locked in the threaded screw hole of the first arm andthe proximal end of the second locking screw is locked in the threadedhole of the second arm and so that the distal ends of the first and thesecond locking screws converge toward each other but do not impinge. 2.The method of conducting a surgery as set forth in claim 1, includingthe further step of contouring the first or the second arm using a platebender.
 3. The method of conducting a surgery as set forth in claim 2,wherein the proximal end of the first locking screw includes a threadand including the further step of locking the first locking screw in thethreaded screw hole of the first arm by engaging the threads of theproximal end of the locking screw in the threads of the first arm screwhole.
 4. The method of conducting a surgery as set forth in claim 3,wherein the proximal end of the second locking screw includes a threadand including the further step of locking the second locking screw inthe threaded screw hole of the second arm by engaging the threads of theproximal end of the locking screw in the threads of the second arm screwhole.
 5. The method of conducting a surgery as set forth in claim 1,wherein one of the first locking screw or the second locking screw are avariable locking screw.
 6. The method of conducting a surgery as setforth in claim 1, wherein the plate further include a compression slot,and including the further step of causing a compression in bone byscrewing a screw into the compression slot.
 7. The method of conductinga surgery as set forth in claim 1, wherein the plate has an inferiorside and each of the first locking screw and the second locking screwhave a proximal end and a distal end which extends from the plate, andthe distal ends of the screws converge toward each other in a directionaway from the inferior side of the plate, but do not impinge.
 8. Themethod of conducting a surgery as set forth in claim 1, wherein each armincludes a linking section joining the arms to the elongate trunk andeach linking section has a waist.
 9. The method of conducting a surgeryas set forth in claim 8, wherein the waist of the linking section of thefirst arm and of the second arm is configured to bend relative to theelongate trunk in response to a force applied to at least one of beforeor during surgery without deforming the threaded screw hole of that arm.10. The method of conducting a surgery as set forth in claim 1, whereinthe plate defines a medial line and the plate is bilaterallyasymmetrical about the medial line.
 11. The method of conducting asurgery as set forth in claim 1, wherein the plate defines a transverseaxis and the plate is bilaterally asymmetrical about the transverseaxis.
 12. The method of conducting a surgery as set forth in claim 1,wherein the plate has only one set of arms and an outline that forms aY-shape.
 13. The method of conducting a surgery as set forth in claim 1,wherein the elongate trunk defines a medial line and the threadedlocking screw holes of a set of arms are placed a radially equaldistance from the medial line of the elongate trunk.
 14. The method ofconducting a surgery as set forth in claim 1, wherein the elongate trunkdefines a medial line and the elongate trunk plate has an inferiorsurface defining a curve transverse to the medial line.
 15. The methodof conducting a surgery as set forth in claim 1, wherein the curve isconstant along the medial line.
 16. The method of conducting a surgeryas set forth in claim 15, wherein the curve is a portion of a circle andthe plate defines a segment of a cylinder.
 17. A method of conducting asurgery on a bone in a patient comprising the steps of: using a platesystem on the bone, the plate system comprising a pre-contoured platehaving an elongate trunk which extends along a longitudinal medial axisand at one end of the longitudinal medial axis only a first arm and asecond arm which diverge from the end of the trunk asymmetricallyrelative to the other arm, and the first arm and second arm eachincluding at least one threaded screw hole, and; inserting a firstlocking screw having a proximal end and a distal end into the threadedscrew hole of the first arm, and a second locking screw having aproximal end and a distal end into the threaded locking screw hole ofthe second arm so that the proximal end of the first locking screw islocked in the threaded screw hole of the first arm and the proximal endof the second locking screw is locked in the threaded hole of the secondarm and so that the distal ends of the first and the second lockingscrews converge toward each other but do not impinge and also so thatthe distal end of the screw is secured in cortical bone.
 18. The methodof conducting a surgery on a bone in a patient as set forth in claim 17,including the further step of providing a plate bender in the surgicaltray, and whereby the plate bender can be used during surgery to furthercontour the two arms without distorting the threaded screw hole.
 19. Themethod of conducting a surgery on a bone in a patient as set forth inclaim 17, wherein each arm includes a linking section joining the armsto the elongate trunk and each linking section has a waist.
 20. Themethod of conducting a surgery on a bone in a patient as set forth inclaim 19, wherein the waist of the linking section of the first arm andthe second arm is configured to bend relative to the elongate trunk inresponse to a force applied to at least one of before or during surgerywithout deforming the threaded screw hole of that arm.
 21. The method offacilitating surgery on a small bone as set forth in claim 17, whereinthe plate further defines a transverse axis and the plate is bilaterallyasymmetrical about the transverse axis.
 22. The method of facilitatingsurgery on a small bone as set forth in claim 17, wherein the plate hasonly one set of arms and an outline that forms a Y-shape.
 23. The methodof facilitating surgery on a small bone as set forth in claim 17,wherein the threaded locking screw holes of a set of arms are placed aradially equal distance from the medial line of the elongate trunk. 24.The method of facilitating surgery on a small bone as set forth in claim17, wherein the plate defines a medial line and the elongate trunk platehas an inferior surface defining a curve transverse to the medial line.25. The method of conducting a surgery on a bone in a patient as setforth in claim 24, wherein the curve is constant along the medial line.26. The method of conducting a surgery on a bone in a patient as setforth in claim 25, wherein the curve is a portion of a circle and theplate defines a segment of a cylinder.
 27. The method of conducting asurgery on a bone in a patient as set forth in claim 17, wherein thesurgery is selected from the group consisting of an osteotomy and afusion surgery.